The path to improving equitable access to healthcare in Canada

If Canada were judged on its ability to provide accessible, equal and timely healthcare to all its citizens, it would receive a failing grade. Out of eleven countries studied in the 2017 Commonwealth Fund report, Canada was ranked second last for overall access to care, and last for timeliness of care [1]. Access is a multifactorial issue, but two key problems that arise are wait times, and equitability. It is widely acknowledged that Canadians need to wait a long time for many health interventions, but it can often erroneously be assumed that equal access and affordability are no longer issues in a universal healthcare system. Evidence demonstrates that this is wishful thinking. As we deal with the Covid 19 pandemic, these challenges protrude in an already failing system.

RPTRA CONCEPT IN THE ARCHIPELAGO: BASED ON AN EQUALITY AND LEGAL PROTECTION APPROACH

The focus of the discussion in this study is on the design and needs of RPTRA in communities with different environmental and cultural contexts. Including the understanding of the surrounding community who "get" the RPTRA regarding the procedures for its use and maintenance. An equally important part is the concept of "child-friendly", what kind of understanding and implementation is there, and its legal basis (particularly for the protection of children in public spaces – RPTRA). This research was conducted on Tidung Island, one of the islands in the South Thousand Islands District, Seribu Islands Regency, DKI Jakarta Province. Several things that need to be considered as a reference in the development of RPTRA in archipelagic areas based on an architectural approach: (1) Access and affordability, (2) Community involvement in RPTRA design, (3) RPTRA which also basically pays attention to children with special needs, (4) Maintaining Green Open Space compared to the existence of buildings, (5) Prioritizing activity facilities that are the choice of the surrounding community, (6) RPTRA design must pay attention to weather conditions in coastal areas, (7) Socialization to the surrounding community on the character of materials and their use, (8 ) RPTRA designer's understanding of zoning and facility classification, (9) Setting zoning activities between toddlers and youth, (10) Utilizing existing facilities outside the RPTRA. Several things that need to be considered as a reference in the development of RPTRA in archipelagic areas based on a legal approach are: (1) The legal aspects of establishing an RPTRA based on the ideal area, (2) The conception of RPTRA as accommodating the idea of ​​a child-friendly city based on existing regulations, (3 ) Legal studies to harmonize RPTRA with the PKK Main Program based on Governor Regulation Number 40 of 2016 have not gone well, (4) Legally (based on Governor's Decree Number 349 of 2015 concerning the Implementation Team for RPTRA Development and Maintenance) the role of RPTRA managers must also be emphasized its main tasks and functions.

Value-based pricing for advanced therapy medicinal products: emerging affordability solutions

The emergence of advanced therapy medicinal products (ATMPs), a disruptive class of health technologies, is generating important challenges in terms of value assessment and their high prices introduce critical access and affordability concerns. The aim of this article is to analyze the challenges of traditional value assessment and price and reimbursement methods in the evaluation of ATMPs and to characterize the current and prospective financing solutions that may ensure patient access and affordability for these health technologies. Standard Health Technology Assessment (HTA) is not designed for ATMPs, and may delay access to these health technologies, thus a broader concept of value is required. As a consequence, value-based pricing methodologies have been gaining terrain to cope with the specific challenges of ATMPs. The pricing and reimbursement framework should ensure the balance between encouragements to innovation and maximization of value for money for payers, through the attribution of a fair price to new health technologies. Early scientific advice by regulatory and HTA bodies to developers is key, as it will contribute to diminish the perspective gap between developers, regulators and payers. The high efficacy/high price dynamic of many advanced therapies will demand novel financing models, both in the EU and US. Managed entry agreements (MEA), with financing being conditional to the submission of additional evidence, associated with methods of leased payments, may offer effective strategies to address the uncertainties caused by the evidence gap associated with ATMPs, ensuring affordable and sustained access.

Statement on Universal Affordable Vaccination against Coronavirus Disease covid-19, International Cooperation and Intellectual Property

Access to a vaccine against coronavirus disease (covid-19) that is safe, effective and based on the best scientific developments is an essential component of the right of everyone to the enjoyment of the highest attainable standard of physical and mental health and the right of everyone to enjoy the benefits of scientific progress and its applications. States therefore have an obligation to take all the necessary measures, as a matter of priority and to the maximum of their available resources, to guarantee all persons access to vaccines against covid-19, without any discrimination. This statement builds on the previous statements of the Committee on Economic, Social and Cultural Rights of 6 April 2020 on the coronavirus disease (covid-19) pandemic and economic, social and cultural rights (E/C.12/2020/1) and of 27 November 2020 on universal and equitable access to vaccines for the coronavirus disease (covid-19) (E/C.12/2020/2). It is intended to remind States of their obligations under the International Covenant on Economic, Social and Cultural Rights in relation to universal access and affordability of vaccines against covid-19, particularly with regard to international cooperation and intellectual property.